Beyond the Match Foundation THERAPY Grant Application
Thank you for your interest in applying for support through Beyond the Match Foundation. We recognize that adoption journeys, especially those involving disruption or financial hardship, can be complex and deeply emotional. Our goal is to walk alongside families by offering both financial assistance and compassionate support. Please complete the application below as thoroughly as you are able. All information shared is kept confidential and used solely for the purpose of evaluating grant applications.
APPLICANT INFORMATION
Please fill out the below information.
Name of applicant:
*
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
*
example@example.com
Spouse/partner name (if applicable):
First Name
Last Name
Phone Number
-
Area Code
Phone Number
E-mail
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Total annual household income:
*
Employment status of applicant(s).
*
YOUR STORY + NEED
Personal Statement
Please share your story and the reason you are seeking therapy assistance through this grant. We understand that every adoption journey is unique, and we want to hear about your specific circumstances and needs. You may choose to include details such as: If you have experienced a disrupted adoption, if you are currently navigating the emotional challenges of waiting in the adoption process, if you are post-finalization and seeking support for yourself, your child, or your family, any emotional, relational, or mental health challenges you are currently facing. This is your opportunity to help us better understand your situation, how therapy support would benefit you or your family, and how this grant could make a meaningful impact. Please share as much as you feel comfortable. All information will be kept confidential and reviewed with care and compassion.
*
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THERAPY GRANT QUESTIONS
Are you currently working with a therapist?
*
Yes
No
No, but actively seeking one.
Other
Therapists name:
Practice name/State:
Is this provider adoption-competent?
*
Yes
No
Unsure
Does your insurance cover these services?
*
Fully covered
Partially covered
Not covered
In-network only
Cost per session:
*
Number of sessions requested for support:
4
6
10
Other
Statement of cost per session:
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Insurance denial or confirmation of non-coverage (if available)
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CONSENT + AGREEMENT
Fill the checkboxes in below and make sure everything in the form is filled out properly.
I certify that the information provided is true and accurate.
I understand that submission does not guarantee funding.
I consent to Beyond the Match Foundation contacting me regarding my application.
Signature
Date
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Month
-
Day
Year
Date
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